Assessment of clinical, electrocardiographic, and physiological relevance of diagonal branch in left anterior descending coronary artery bifurcation lesions

Bon Kwon Koo, Seung Pyo Lee, Ju Hee Lee, Kyung Woo Park, Jung Won Suh, Young Seok Cho, Woo Young Chung, Joon Hyung Doh, Chang Wook Nam, Cheol Woong Yu, Bong Ki Lee, Dobrin Vassilev, Robert Gil, Hong Seok Lim, Seung Jea Tahk, Hyo Soo Kim

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


Objectives: This study sought to investigate the clinical, electrocardiographic, and physiological relevance of main and side branches in coronary bifurcation lesions. Background: Discrepancy exists between stenosis severity and clinical outcomes in bifurcation lesions. However, its mechanism has not been fully evaluated yet. Methods: Sixty-five patients with left anterior descending coronary artery (LAD) bifurcation lesions were prospectively enrolled. Chest pain and 12-lead electrocardiogram were assessed after 1-min occlusion of coronary flow and coronary wedge pressure (Pw) was measured using a pressure wire. Results: ST-segment elevation was more frequent during LAD occlusion (92%) than during diagonal branch occlusion (37%) (p < 0.001). Pain score was also higher with the occlusion of LAD than with the diagonal branch (p < 0.001). However, both Pw and Pw/aortic pressure (Pa) were lower in the LAD than in diagonal branches (Pw: 21.0 ± 6.5 vs. 26.7 ± 9.4, p < 0.0001; Pw/Pa: 0.22 ± 0.07 vs. 0.27 ± 0.08, p = 0.001). The corrected QT interval was prolonged with LAD occlusion (435.0 ± 39.6 ms to 454.0 ± 45.4 ms, p < 0.0001) but not with diagonal branch occlusion. There was no difference in vessel size between the diagonal branches with and without ST-segment elevation during occlusion. Positive and negative predictive values of vessel size (<2.5 mm) to determine the presence of ST-segment elevation were 48% and 72%, respectively. Conclusions: Diagonal branch occlusion caused fewer anginas, less electrocardiogram change, less arrhythmogenic potential, and higher Pw than did a LAD occlusion. These differences seem to be the main mechanism explaining why aggressive treatment for side branches has not translated into clinical benefit in coronary bifurcation lesions. (Comparison Between Main Branch and Side Branch Vessels; NCT01046409)

Original languageEnglish
Pages (from-to)1126-1132
Number of pages7
JournalJACC: Cardiovascular Interventions
Issue number11
Publication statusPublished - 2012 Nov
Externally publishedYes

Bibliographical note

Funding Information:
This study was supported by grants from the Korean Society of Interventional Cardiology , Seoul, Republic of Korea ( 2009 ), Innovative Research Institute for Cell Therapy , the Clinical Research Center for Ischemic Heart Disease (no. 0412-CR02-0704-0001 ) sponsored by the Ministry of Health and Welfare, Republic of Korea and the Seoul National University Hospital Research Fund (no. 03-2010-0270 ). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.


  • bifurcation
  • coronary disease
  • electrocardiography
  • physiology
  • stenosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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